[Treatment of tibial plateau fractures between the priorities of reconstruction and arthroplasty].

Tibial plateau fractures are complex intra-articular injuries associated with a considerable risk of post-traumatic osteoarthritis and potential future total knee arthroplasty (TKA). Traditionally, treatment strategies focus on anatomical reconstruction based on fracture morphology; however, demographic changes and the increasing incidence of fragility fractures require a more patient-specific treatment approach. In younger patients, anatomical reconstruction aiming to restore joint congruity, tibial plateau width and mechanical alignment remains the primary goal. In contrast, older patients with osteoporotic bone, complex fracture patterns and limited compliance with postoperative weight-bearing restrictions may benefit from alternative strategies, including primary arthroplasty in selected cases. In addition to fracture morphology and patient factors, the choice of surgical approach plays a crucial role. Surgical approaches influence soft tissue conditions, scar formation and implant positioning, which may affect the feasibility and complexity of future TKA. Bone quality and augmentation techniques must also be considered as they influence fracture healing, implant stability and potential future arthroplasty. This article discusses current concepts in the management of tibial plateau fractures with particular focus on patient-specific treatment strategies and implications for future knee arthroplasty.